WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDTION TRUST REPORT TO THE BOARD OF DIRECTORS. AGENDA ITEM 09 MONTH October 2015 PAPER NUMBER 06B

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1 Title Sponsoring Director Patient Quality Report Mark Docherty, Director of Nursing, Quality & Clinical Commissioning Dr Andrew Carson, Medical Director Author(s)/ Presenter Mark Docherty, Director of Nursing, Quality & Clinical Commissioning Dr Andrew Carson, Medical Director Purpose The purpose of this report is: To provide assurance in relation to implementation of the key areas contained within the Quality Strategy To identify risks and actions taken to mitigate risks that may affect the achievement of strategic objectives. To provide an overview of forthcoming projects, actions, events and initiatives that will progress delivery plans Previously Considered by The risks and information contained within the report together with supporting documentation have been reviewed by: Quality Governance Committee Executive Summary The report provides an update and means of assurance to the Board in the following areas: Safety Patient Experience Clinical Effectiveness The report is a high level summary. Detailed activity and performance information is detailed within the Trust Information Pack Related Trust Objectives / National Standards Risk and Assurance Legal implications/ regulatory requirements Financial Planning Workforce Implications Communications This report supports the achievement of all Trust Strategic Objectives Assurance is provided via the Quality Governance Committee The paper focuses on significant risks 1 & 3 contained within the Assurance Framework. The report forms a significant part of the requirements of maintaining CQC registration and licence. Safety, Effectiveness and Experience are an integral part of all financial planning. There is reference in the report that relates to workforce implications, in particular reference to the provision of quality and patient care. Communication to staff is through various channels including Weekly brief. The report contains reference to the patient experience which includes complaints and PALs contact. Page 1 of 8

2 Equality and Diversity Implications Quality Impact Assessment Data Quality Strategies and plans must be subject to an impact assessment. The report focuses on all elements of quality Verified through Clinical Audit processes Learning Review Group Performance Cell Directorate Leads Action required by the Board The Board of Directors is asked to note the report. Page 2 of 8

3 High Impact Changes The nine high impact changes have been developed nationally from the good practice in Safer, Faster, Better, recently published by NHS England. 1. Establishing urgent care clinical hubs 2. Improving access to community health and social care rapid response services 3. Increasing direct referral to all other components of the Urgent and Emergency Care Network 4. Enhanced working with community mental health teams 5. Enhanced working with primary care 6. Workforce development 7. Enhanced use of information and communication technologies 8. Increased use of alternative vehicles to convey patients 9. For patients who do need to be taken to hospital, ambulance services should seek to minimise handover delays Progress on the delivery of these is monitored through the Executive Management Board as well as through the System Resilience Group assurance process. The current position on delivery of these is summarised in the enclosed appendix Safety 2.1 Patient Safety Incidents During Qtr we have received and managed a total of 157 patient safety incidents (inclusive of serious incidents) have been reported in the form of WMAS 54 s, NHS to NHS concerns and SI s. This data includes 107 concerns relating to incidents which have been raised by other providers as NHS to NHS concerns. Themes The Learning Review Report identified an increasing theme of an increase in patient harm for PTS patients relating to skin tears which are sometimes caused by contact collision on a wheelchair. There appears to be an increase in the equipment specifically that of diagnostics, which was due to the introduction of the Medescan Thermoscan Thermometer Actual Harm Of the total number of incidents reported; 8 have resulted in actual harm all of which are minor such as skin tears, minor laceration and grazes and Serious Incidents were harm is to be determined. In July, 7 harm incidents were reported; all 7 were low harm 3 were serious incidences In August 1 harm incidents were reported which was low harm. 2 were reported as serious incidences Page 3 of 8

4 In September 0 harm incidents were reported and 1 Serious Incident 2.2 Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) Reports April 2015 to date There have been 11 incidents (YTD) reported. 9 of these have been reported within the 15 day time-frame. The recent improvement in reporting timeliness has been maintained. The average number of days to report for all RIDDOR incidents is 8 days. 2.3 Serious Incidents (SI) Serious Incidents (SIs) A total of 9 SIs have been reported so far this financial year and are currently under investigation: Summaries can be found in the Qtr 2 LRG report. 2.4 Claims In July 2015 the Trust received 1 staff and 2 patient claims. In August 2015 the Trust received 3 staff and 4 patient claims. In September 2015 the Trust received 2 staff and 1 patient claims. 2.5 Medicines Management Accountable Officer Report Adverse Incidents In August / September 2015, the Trust registered no medicine SIs. One yellow card yellow card incident was reported. (This was as a result of a patient being given Adrenaline via the I.V route instead of the correct I.M route). Note, the patient did not suffer any lasting harm and an RCA has identified several initiatives which will reduce the risk of this happening again. Morphine Management During August 2015, 17 CDI reports were received. In September 2015, 7 CDI reports were received. This compares with 11 CDIs reported in June 2015 and 10 CDIs reported in July Page 4 of 8

5 August 2015; 17 CDI reports as follows; o 1 classed as a loss (X2 ampoules) Loss occurred at Aston fire station. The CDI drug register indicated that 22 ampoules of morphine should be present in the CD safe. An audit highlighted the stock as 20 ampoules. (2 ampoules missing). This case is still the subject of an ongoing investigation. o 16 classed as breakages 8 x Morphine ampoules 2 x Oral morphine 6 x Diazemuls ampoules 0 other CDI incidents reported September 2015; 7 CDI reports as follows; o 0 classed as a loss. o 4 classed as breakages (and 3 other CDI incidents.) 3 x Morphine ampoules 0 x Oral morphine 1 x Diazemuls 3 other CDIs incidents as follows, o Member of staff lost the key for the ambulance drug safe, therefore could not return the Controlled Drugs to the station CD safe. o A paramedic left his CD drugs at the ED. (medicines recovered intact) o 2 Tubes off diazepam found to be empty. (Tubes still in their manufactures packaging returned to supplier for review). Note; all of the above issues have been managed by the relevant hub managers and no cause for concern was identified in any of these incidents. 3 Patient Experience 3.1 Formal Complaints In July 2015 the main reason for a complaint was in relation to Attitude and Conduct and Clinical both receiving 10 contacts. Clinical: 1 relating to the Non-Emergency Patient Transport Service and 9 related to the Emergency Service. Professional Conduct: 2 relating to the Non-Emergency Patient Transport Service and 8 related to the Emergency Service. Page 5 of 8

6 In August 2015 main reason for a complaint was in relation to Attitude and Conduct (9), 2 relating to the Non-Emergency Patient Transport Service and 7 to Emergency Services. In September 2015 main reason for a complaint was in relation to Clinical (15), 2 relating to the Non-Emergency Patient Transport Service and 13 to Emergency Services. With the majority relating to patient care. Year to Date - There were a total of 169 complaints recorded from 1 April 2015 to 30 September 2015 compared to 177 for Qtr1 and Qtr 2 of 2014/15. A 4.5% decrease. 3.2 Patient Advice Liaison Service (PALS) Contacts In July 2015 it was noted that there had been 86 PALS contacts compared to 107 for the same period in 2014/15 a reduction of 19.6%. The main reason for a complaint during this period was in relation to response (22), 18 relating to the Non-Emergency Patient Transport Service and 4 related to the Emergency Service. In August 2015 it was noted that there had been 79 PALS contacts compared to 117 for the same period in 2014/15, a reduction of 32.5%. The main reason for a complaint during this period was in relation to attitude and conduct (18), 1 relating to the Non-Emergency Patient Transport Service, 14 related to the Emergency Service, and 3 other. In September 2015 it was noted that there had been 97 PALS contacts compared to 108 for the same period in 2014/15, a reduction of 10.2%. The main reason for a complaint during this period was in relation to response (21), 15 relating to the Non-Emergency Patient Transport Service and 6 related to the Emergency Service. Year to Date (1 April September 15) - The total number of contacts received in 2015/16 was 518 compared to 662 in 2014/15 showing a decrease of 21.8%. 3.3 Compliments Year to Date (1 April September 15) - the Trust received a total of 642 contacts of appreciation from the public compared to 582 in 2014/2015. Page 6 of 8

7 3.4 Friends and Family Test Quarter 2: The Trust have received 9 responses from patients that have dialled 999 and received an emergency response but did not require conveyance to hospital. 8 responses have been received from patients that utilise the Non Emergency Patient Transport Service. Type Emergency Service Patient Transport Service Extremely Unlikely Neither Likely Extremely Likely Don t Know Total Patient Survey Results: A randomly selected number of patients that received an emergency response were selected to complete a questionnaire from attendee s in Quarter patients were selected and they have been asked to complete and return the survey to the Patient Experience Team by 30 October Ambulance Turnaround Delays: The Board is asked to note a significant concern that has been logged in relation a deteriorating position with regard to ambulance patient handover delays at acute hospitals. The national target performance is that a patient handover is completed within 15 minutes of arrival at hospital, and the vehicle is ready to respond to the next call 15 mins after. In one ten day period (2 October 2015 to 11 October 2015) there were: 154 patient handover delays of over 60 mins (target zero) 834 hours of lost ambulance resource in handover delays in excess of 30 minutes Cost of lost resource during this period of time = 100k In addition to the above, recent experience of patients going to hospitals in Wales has also resulted in some significant delays. Delays in patient handover at acute hospitals may result in: Poor patient experience Potential harm from delay Risk to other service users whose response is delayed Poor staff morale Page 7 of 8

8 As a result of the significant concern that has been raised the following actions have been taken: The issue has been escalated to responsible commissioners, regulators and the CQC in a letter sent on 12 October 2015 The delays in hospitals in Wales has also been escalated to the Minister for Health and Social Services at the National Assembly for Wales Reports on ambulance turnaround delays are sent widely on the daily Strategic Operations Cell (SOC) reports A comprehensive risk assessment is being undertaken to identify all relevant issues Discussions with commissioners are taking place to consider how the lost resource is compensated 4. Clinical Effectiveness Refer to the clinical performance scorecard. Craig Cooke, Emergency Services Director Mark Docherty, Director of Nursing, Quality & Clinical Commissioning Dr A Carson, Medical Director October 2015 Page 8 of 8

9 High Impact Actions 1. Establishing urgent care clinical hubs - All services to progress Clinical hub development with wider MDT and specialist input. The expertise accessible through an urgent care clinical hub, on a 24/7 basis, could include (but is not limited to): pharmacy; dental; midwifery; mental health crisis and liaison psychiatry; end of life care; respiratory (including COPD); paediatrics; care of the elderly; drug and alcohol services; social care; secondary care expertise including general medicine and general surgery. status Birmingham Black Country Arden Staffs West Mercia WMAS have a CSD in existence, and a WMAS have a CSD in existence, and a well developed DoS. Under the 111 WMAS have a CSD in existence, and a well developed well developed DoS. Under the 111 plan, WMAS would have had an integrated clinical Hub. DoS. Under the 111 plan, WMAS would have had an plan, WMAS would have had an integrated clinical Hub. integrated clinical Hub. The integration of the 111 hub with the 999 hub is unlikely to be achieved for winter 2015/16. Some elements are supplying some of this service e.g. mental health care, falls services. Please comment on risks to delivery, and provide what mitigating actions you are putting in place. Please also include a timescale for full implementation. The integration of the 111 hub with the 999 hub is unlikely to be achieved for winter 2015/16. Some elements are supplying some of this service e.g. mental health care, falls services. We are currently developing our urgent care plans with a view to placing an ECP + Advanced Paramedic in the Coventry Walk-in centre and engagement is. The intention would be for ambulance crews to be able to phone for advice or convey patients with minor conditions direct to the urgent care centre and by-pass the Emergency Department. Our plans are to develop an integrated urgent care provision in Coventry and intend to agree commissioners a provision for trial before the winter period. This is envisaged to reduce activity to UHCW by around 10%. The integration of the 111 hub with the 999 hub is unlikely to be achieved for winter 2015/16. Staffordshire EOC have an Telemedicne link to the SSOTP Clinical Hub. The risks are that there are insufficient Clinicians based in the SSOTP Hub to manage the demand. Ambulance handover is delayed at scene due to extended and or protracted conversations The telemedicine desk is funded until March 2016 WMAS have a CSD in existence, and a well developed DoS. Under the 111 plan, WMAS would have had an integrated clinical Hub. The integration of the 111 hub with the 999 hub is unlikely to be achieved for winter 2015/16. Shropshire has a Care Coordination Centre and Out of Hours which crews can refer to and gain advice through a Health Professional line. This has the up to date DOS and links in closely with the community hospitals and rapid response/fall services. In Worcestershire we have a dedicated phone number for each GP surgery in hours with direct contact, this is also being rolled out in Herefordshire. Some elements are supplying some of this service e.g. mental health care, falls services. 2. Improving access to community health and social care rapid response, including falls services - Ambulance services should have (or have plans to put in place) direct access to these services, through simple routes of referral (e.g. a single point of access for professionals/single phone call) as an effective alternative to A&E conveyance and/or hospital admission. A continual review of the services available on the DoS is undertaken the Black Country DoS lead to ensure all services are described. The DoS lead maintains good, open communications with the CCG and service providers. CCGs provide some of this access. We will work with CCGs to ensure that where WMAS can access alternative services this is achievable. A continual review of the services available on the DoS is undertaken the Black Country DoS lead to ensure all services are described. The DoS lead maintains good, open communications with the CCG and service providers. CCGs provide some of this access. We will work with CCGs to ensure that where WMAS can access alternative services this is achievable. WMAS have a Clinical Desk operating with a clinician available for crews 24/7 seeking services as an alternative to conveyance to hospital (DoS) and has done for a number of years. This has been in place for a number of years and is currently being revised with a lead officer in place to improve and promote its use. A review of the services available on the DoS needs to be undertaken to ensure all services are described. CCGs provide some of this access. We will work with CCGs to ensure that where WMAS can access alternative services this is achievable. WMAS Staffordshire have developed a KPi on falls with the SRG relating to Falls which is achieving consistently. The Telemedicine desk inconjucntion with funding from the CCGs to support this initiative provides a single point of access. Risks are calls volumes rise in winter so access to these schemes becomes slower. Operational ambulance Crews cannot wait at incidents for call backs for elongated periods, which then results in a transport to A&E A review of the services available on the DoS needs to be undertaken to ensure all services are described. A review of the services available on the DoS needs to be undertaken to ensure all services are described. CCGs provide some of this access. We will work with CCGs to ensure that where WMAS can access alternative services this is achievable. Direct access to GP surgeries in hours (H&W) and Care Co ordination (Shropshire). Falls services in Herefordshire & Worcestershire. ECP's working in Herefordshire. A review of the services available on the DoS needs to be undertaken to ensure all services are described. CCGs provide some of this access. We will work with CCGs to ensure that where WMAS can access alternative services this is achievable. A review of the services available on the DoS needs to be undertaken to ensure all services are described. CCGs provide some of this access. We will work with CCGs to ensure that where WMAS can access alternative services this is achievable. 3. Increasing direct referral to all other components of the Urgent and Emergency Care Network - Registered healthcare professionals in the employment of ambulance services (e.g. paramedics and nurses) should be empowered and supported to refer patients that they have assessed in person to all other components of the urgent and emergency care network. This includes referral to primary care and hospital-based expertise, combined with conveyance to non-a&e destinations including urgent care centres, assessment units and ambulatory emergency care units. In plans for implementation DoS leads ensure that all alternative services are on the DoS. Current high levels of non-conveyance is good. but a project has began to offer WMAS paramedics telephone access to a duty doctor via a private line in order to discuss a patient s clinical condition whilst on scene. The objective of the project is to reduce the number of patients registered with participating practices who are conveyed to Emergency Departments having dialled 999, WMAS is working with Birmingham cross city CCG to drive this forward. DoS leads ensure that all alternative services are on the DoS. Current high levels of non-conveyance is good. There is a Specialist Paramedic Emergency Practitioner working in the Wolverhampton and Walsall CCG areas who has developed enhanced access to Community and Acute setting specialties, providing senior support for ambulance staff to further reduce conveyance to ED's. This team is funded from the local SRG's. In Dudley CCG there are ANP's that are now first responders for WMAS in their CCG area and take direct referral from crews using WMAS radios. Access to a mobile DoS will be available to front-line staff from Autumn 2015, and be complete by All paramedics are autonomous clinicians and have received training in using alternative pathways and patient assessment. Staff can access commissioned services through the Clinical Desk who has access to the DOS to undertake appropriate referrals. Target is 30% and currently at35.1%. Staff are encouraged to use alternative pathways in training and appraisals with support in place through managers and training department. A number of GP appointments can be accessed via the Clinical Desk in the Emergency Operations Centre. Paramedics are appropriately trained to see and treat at the scene. The initiative described at section 1 would also enable practitioners to use community services to further avoid hospital admission. DoS leads ensure that all alternative services are on the DoS. Current high levels of non-conveyance is good. Access to a mobile DoS will be available to front-line staff from Autumn 2015, and be complete by Ambulance clinicians do refer patients to primary care as part of their daily role., as well as utilising the number of alternative pathways open to them. However there are assoiciated risks, not all Urhgent care Centres or Walk In Centres offer the same process, the Inclusion criterias are narrow, which stifles access to such centres. Nursing staff of varying experiences will affect the ability to habnd patienyts over DoS leads ensure that all alternative services are on the DoS. Current high levels of non-conveyance is good. Access to a mobile DoS will be available to front-line staff from Autumn 2015, and be complete by There are Advanced Paramedics based at Community Ambulance Stations across West Mercia and ECP's in Herefordshire. Ambulance staff routinely refer patients to avoid hospital admissions and this is relected in the non conveyances across Herefordshire, Shropshire & Worcestershire where YTD is 57%. In Worcestershire there is also the GP service that covers the weekends and BH's from hrs (3 GP's in total) 4. Enhanced working with community mental health teams - Ambulance services should work with SRGs, commissioners, community mental health teams and other system partners to improve access to early triage and assessment by mental health professionals following referral from the ambulance service. This should be supported by timely access to crisis care at home and in community-based settings. The Birmingham has a Mental Health street triage car that runs 7 days a week with a Paramedic, CPN and Police Officer to support patients and good partnership working to support the health community. The Black Country has a Mental Health street triage car that runs 7 days a week with a Paramedic, CPN and Police Officer to support patients and good partnership working to support the health community. The ambulance services work closely with AMHAT and 24 hour crisis team to ensure appropriate referral and triage. There is a 'Mental Health' car that currently operates in Coventry crewed by a Police Officer and a Mental Health Nurse working , 7 days a week. Discussions are ongoing to use this as a pathway for ambulance staff for advice or referral. WMAS have 2 mental health cars (Birmingham and Black Country), and other mental health cars exits, but WMAS are not able to refer in to some of these (e.g. Coventry). There remains a disparity in regferring patient directly to mental Health Units which would ease the pressure on acute Trusts. WMAS have 2 mental health cars (Birmingham and Black Country), and other mental health cars exits, but WMAS are not able to refer in to some of these (e.g. Coventry). Mental health access/provision needs enhancing in Herefordshire and Worcestershire. Shropshire have a triage line available for WMAS. High Impact Changes

10 High Impact Changes 5. Enhanced working with primary care - In addition to the referral and transport actions outlined under point 3 above, consideration should be given to: paramedic practitioners undertaking acute home visits on behalf of GPs, to avoid unnecessary admission and admission surges; call back schemes whereby in-hours and out-of-hours primary care staff follow-up patients who have been managed at home and not transported by ambulance clinicians (within agreed time-frames); joint planning with GPs and other relevant system partners (e.g. acute trusts) to agree management plans for high-volume service users/frequent callers. funding has been secured from both Solihull CCG and also Birmingham cross city CCG for two High Intensity Service user manager to actively manage the local health community frequent callers within Birmingham. Plans are in place in SWB CCG and considerations in Wolverhampton for a High Intensity Service user manager to actively manage the local health community frequent callers. This service is not currently commissioned to work in Primary Care as paramedic practitioners and are a currently a planned resource for response to emergencies. High volume service users are identified each month and staff on alternative duties are assigned to work with these patients, their GPs, social worker, Police and any other agency to provide a plan for their health care and reduce the number of calls. However, further discussions are ongoing with Coventry & Rugby CCG to commission a substantive position that would provide consistency and develop better experience in dealing with this group of patients. Placing clinicians alongside paramedics in cars as not delivered huge benefits following a Staffordshire Trial in 14/15 the Car delivered 66% which was extremely good, howeer the Matron on the car contributed to only 9% of the non conveyance. Process in place in both North and South staffordshire relating to High Volume Service users with ambulance clinicains linkedwith the CCGs and the working groups of the SRGs, the risk to this is that CCGS do not fund or assist in the funding to support these positions In Herefordshire some of the Community Ambulance Stations work closely with GP surgeries and paramedics will go out and visit patients. Good practice is at Bromyard. Herefordshire CCG are keen to enhance this across the county. 6. Workforce development - The development and up-skilling of the ambulance workforce (particularly paramedics) and the employment of a wider range of healthcare professionals (e.g. nurses, midwives and pharmacists) will increase the rates of both see and treat and hear and treat by enhancing the skills of the ambulance workforce. 7. Enhanced use of information and communication technologies - This includes (but is not limited to): sharing and access to electronic patient records to support clinical decision-making; implementation of electronic patient handovers; sharing predicted activity levels with acute trusts on an hourly and daily basis to trigger effective escalation protocols. 8. Increased use of alternative vehicles to convey patients - Ambulance services should consider the use of alternative vehicles to transport patients, whenever it is safe and appropriate to do so, thereby freeing up and improving the availability of front line ambulance resources. 9. For patients who do need to be taken to hospital, ambulance services should seek to minimise handover delays - Handover delays to be minimised by Reviewing patients conditions and needs en-route and sending details ahead to the receiving emergency department in the case of any special requirements/circumstances. Avoiding the use of ambulance trolleys for patients who are able to walk into the department. Using alternative vehicles to convey patients to the emergency department (e.g. patient transport service vehicles to transport patients, thus keeping paramedic staffed ambulances available. Implementing electronic patient handovers. Sharing predicted activity levels with acute trusts on an hourly and daily basis to trigger effective escalation when demand rises. WMAS have a workforce plan to ensure that we deliver a 70% Paramedic skill mix. New staff are being trained to ensure workforce delivery. WMAS have a workforce plan to ensure that we deliver a 70% Paramedic skill mix. New staff are being trained to ensure workforce delivery. Starting - 2,195 April 2015 Finishing - 2,464 March 2016 Starting - 2,195 April 2015 Finishing - 2,464 March 2016 This is being addressed via the epr project that is being rolled out from This is being addressed via the epr project that is being rolled out from Autumn 2015 onwards (roll-out is an Autumn 2015 onwards (roll-out is an 18 month timescale) 18 month timescale) Hospitals & CCG's have access to WMAS extranet; which contains transport Hospitals & CCG's have access to forecast BY HOSPITAL, BY HOUR ; BY DAY: as well as conveyance; case WMAS extranet; which contains information on a daily basis. Hospitals all have access to CAD on line (Live). transport forecast BY HOSPITAL, BY Lead Commissioners receives a daily containing hospital activity for HOUR ; BY DAY: as well as the previous day; conveyance; case information on a Internally- All managers have access to Orbit which contains live reports on daily basis. Hospitals all have access to Performance; activity; hospital delays; vehicle availability; Officers on duty; CAD on line (Live). Lead call stacking; Hourly auto- s detailing live situation, Commissioners receives a daily as well as hospital delays; containing hospital activity for the previous day; Internally- All managers have access to Orbit which contains live reports on Performance; activity; hospital delays; vehicle availability; Officers on duty; call stacking; Hourly auto- s detailing live situation, Healthcare Referral vehicles are being used for transport, and WMAS RRVs. All Acutes and receiving units in the WMAS area have web-access to CAD- Online to be able to view what ambulance activity is inbound to them in a live manner, complete with ETA. There is a drill-down on each case to allow receiving departments to view the chief complaint and pertinent case notes in order for them to prepare accordingly. Should there be any special procedures put in place (eg bariatric case, infection control, etc.) the crews will either: o Pre-alert the department prior to leaving scene of incident (Clinician to Clinician) to arrange, or o Contact the WMAS Hospital Desk (either via ARP or telephone). The Hospital Desk will then either contact the HALO (if on duty) or the department direct If the patient s condition requires, WMAS resources will contact the department directly (clinician to clinician) to provide a full pre-alert message to ensure proper measures are in place upon their arrival If the patient is Major Trauma Triage Healthcare Referral vehicles are being used for transport, and WMAS RRVs. All Acutes and receiving units in the WMAS area have web-access to CAD- Online to be able to view what ambulance activity is inbound to them in a live manner, complete with ETA. There is a drill-down on each case to allow receiving departments to view the chief complaint and pertinent case notes in order for them to prepare accordingly. Should there be any special procedures put in place (eg bariatric case, infection control, etc.) the crews will either: o Pre-alert the department prior to leaving scene of incident (Clinician to Clinician) to arrange, or o Contact the WMAS Hospital Desk (either via ARP or telephone). The Hospital Desk will then either contact the HALO (if on duty) or the department direct If the patient s condition requires, WMAS resources will contact the department directly (clinician to clinician) to provide a full prealert message to ensure proper measures are in place upon their arrival If the patient is Major Trauma Triage Tool Positive (assessed by the Critical Care Paramedic on the Regional trauma Desk in the WMAS Regional Coordination Centre), the most appropriate Trauma Unit or Trauma Centre will be pre-alerted accordingly clinician to clinician, Where possible and clinically appropriate, patients will be conveyed from ambulance to receiving unit/department using transfer aids Staff have regular training and provide see and treat interventions. WMAS is currently undergoing a recruitment campaign for student paramedics in order to increase the paramedic numbers to 70% to ensure a paramedic on every ambulance. Arden is currently operating at 47% and will not achieve the numbers this financial year, but making progress. WMAS is currently in the process of implementing electronic patient records for use by operational staff. This facility will enable pertinent information to be captured electronically and shared with other health providers where appropriate. This will also give the ability to obtain better information in respect to conditions and treatments dealt with almost immediately to aid planning in improving clinical outcomes. All hospitals have access to the WMAS CAD to monitor forecasted/actual activity by the hour and day to better plan there staffing and bed states to ensure timely patient handovers. WMAS have a workforce plan to ensure that we deliver a 70% Paramedic skill mix. New staff are being trained to ensure workforce delivery. Starting - 2,195 April 2015 Finishing - 2,464 March 2016 This is being addressed via the eprf project that is being rolled out from Autumn 2015 onwards (roll-out is an 18 month timescale) Hospitals & CCG's have access to WMAS extranet; which contains transport forecast BY HOSPITAL, BY HOUR ; BY DAY: as well as conveyance; case information on a daily basis. Hospitals all have access to CAD on line (Live). Lead Commissioners receives a daily containing hospital activity for the previous day; Internally- All managers have access to Orbit which contains live reports on Performance; activity; hospital delays; vehicle availability; Officers on duty; call stacking; Hourly auto- s detailing live situation, as well as hospital delays; On site Halos provide uptodate information on current activity situation and will also provided forecasted activity for the coming week etc Healthcare Referral vehicles are being used for transport, and WMAS RRVs. The loss of the non WMAS currently operates a bariatric vehicle which is emergency contracts in Staffordshire severly impacted fully equipped to deal with bariatric patients and on the ability to diversify in transport arrangements so available as required. The Patient Transport Services there are only Ambulances and Rapid response Cars to arm is also commissioned to provide High undertake the transport process. Dependency vehicles that can undertake transports such as repatriation following treatment thus freeing up emergency ambulances. High Dependency vehicles have now been contracted by the Patient Transport Services (PTS), which can assist in discharges and certain transports instead of utilising frontline emergency ambulances, thus freeing up resource. The points indicated on the left are already in practice with Hospital Ambulance Liaison Officers (HALO) in place to ensure ambulance crews are using the correct places for the patient condition. All Acute hospitals have access to WMAS data via CAD On-line showing activity and performance for WMAS with report packs shared on a monthly basis. On a regional basis, there is a Hospital Desk in place that monitors all hospitals and takes appropriate action together with the SOC Commander where required eg turnaround delays, support, teleconferences etc. A Trauma Desk is also in place for crews to access when dealing with major trauma. They can offer advice and inform crews of the best unit to convey the patient for treatment. All Acutes and receiving units in the WMAS area have web-access to CAD-Online to be able to view what ambulance activity is inbound to them in a live manner, complete with ETA. There is a drill-down on each case to allow receiving departments to view the chief complaint and pertinent case notes in order for them to prepare accordingly. Should there be any special procedures put in place (eg bariatric case, infection control, etc.) the crews will either: o Pre-alert the department prior to leaving scene of incident (Clinician to Clinician) to arrange, or o Contact the WMAS Hospital Desk (either via ARP or telephone). The Hospital Desk will then either contact the HALO (if on duty) or the department direct If the patient s condition requires, WMAS resources will contact the department directly (clinician to clinician) to provide a full pre-alert message to ensure proper measures are in place upon their arrival If the patient is Major Trauma Triage Tool Positive (assessed by the Critical Care Paramedic on the Regional trauma Desk in the WMAS Regional Coordination Centre), the most appropriate Trauma Unit or Trauma Centre will be pre-alerted accordingly clinician to clinician, Where possible and clinically appropriate, patients will be conveyed from ambulance to receiving unit/department using transfer aids In Staffordshire there as been a seconded position for WMAS have a workforce plan to ensure that we deliver a 70% Paramedic skill mix. New staff are being trained to ensure workforce delivery. Starting - 2,195 April 2015 Finishing - 2,464 March 2016 This is being addressed via the eprf project that is being rolled out from Autumn 2015 onwards (rollout is an 18 month timescale) Hospitals & CCG's have access to WMAS extranet; which contains transport forecast BY HOSPITAL, BY HOUR ; BY DAY: as well as conveyance; case information on a daily basis. Hospitals all have access to CAD on line (Live). Lead Commissioners receives a daily containing hospital activity for the previous day; Internally- All managers have access to Orbit which contains live reports on Performance; activity; hospital delays; vehicle availability; Officers on duty; call stacking; Hourly auto- s detailing live situation, as well as hospital delays; Healthcare Referral vehicles are being used for transport, and WMAS RRVs. Shropshire and T&W CCG's are maximising the HCRT crews from the NEPTS contract to undertake some GP urgents and hospital transfers. All Acutes and receiving units in the WMAS area have web-access to CAD-Online to be able to view what ambulance activity is inbound to them in a live manner, complete with ETA. There is a drilldown on each case to allow receiving departments to view the chief complaint and pertinent case notes in order for them to prepare accordingly. Should there be any special procedures put in place (eg bariatric case, infection control, etc.) the crews will either: o Pre-alert the department prior to leaving scene of incident (Clinician to Clinician) to arrange, or o Contact the WMAS Hospital Desk (either via ARP or telephone). The Hospital Desk will then either contact the HALO (if on duty) or the department direct If the patient s condition requires, WMAS resources will contact the department directly (clinician to clinician) to provide a full pre-alert message to ensure proper measures are in place upon their arrival If the patient is Major Trauma Triage Tool Positive (assessed by the Critical Care Paramedic on the Regional trauma Desk in the WMAS Regional Coordination Centre), the most appropriate Trauma Unit or Trauma Centre will be pre-alerted accordingly clinician to clinician, Where possible and clinically appropriate, patients will be conveyed from ambulance to receiving unit/department using transfer aids In West Mercia we have HALO provision in Worcestershire only which is 2 x WTE's, one based at the AGH and one at WRH. WRH is extremely challenged and there is a significant amount of WMAS resource/ managers hours in cohorting patients/assisting with handovers. Shropshire are equally challenged and there is no HALO provision and as a result the back drop is WMAS managers/resources.